Health & Fitness A Pox Upon Us

February 14, 1989|By DR. PERRI KLASS, New York Times Syndicate

You bring your sick child to an emergency room. The receptionist takes one look and hustles you away from other waiting patients. You are put into a special-precaution room at the far end of the emergency ward separated from the corridor by double doors festooned with warning signs. There will be a wait, the nurse tells you; the one doctor who is available right now won`t see your child.

The dread disease? Chicken pox. There are other more serious infections (bacterial meningitis, AIDS, trichinosis, cholera, leprosy), but chicken pox spreads wildly, far more easily than any of those. One kid with chicken pox sitting in a waiting room can infect every other vulnerable child there. One hospital worker who is exposed to chicken pox and then comes to work can close down an intensive-care unit. Chicken pox is the scourge of the pediatric ward; no other infection so regularly provokes such panic.

Remember chicken pox? I had it when I was 6 years old. I had mumps, too, though I missed out on measles and rubella (German measles), thanks to immunization.

Chicken pox is just about the only routine childhood illness left, the only major infectious disease that almost everybody gets in the first decade of life, and although a new vaccine is being tested, it is not yet generally available.

In a way, chicken pox may be the child`s introduction to illness. Sure, there are colds and ear infections, 24-hour bugs and upset stomachs, but chicken pox is a Disease with a capital D, a distinct entity with clear signs and symptoms. It has a classic rash, poetically described in medical textbooks as ``a dewdrop on a rose petal.`` Stay home from school, try not to scratch. You`re told ``not to worry, it`s only chicken pox -- everybody gets better.``

So why in the hospital are we so paranoid about varicella zoster, to use the medical term?

The fact is, certain patients don`t do so well -- particularly children whose immune systems are weak for one reason or another, children receiving chemotherapy, for example. Those kids are susceptible to a far more serious form of chicken pox, disseminated varicella, one that has a mortality rate of 20 percent. Newborn babies are vulnerable, as are unborn babies. If a woman gets varicella early in pregnancy, the virus is known in rare cases to cause malformations in the fetus; if she gets it a few days before delivery the baby can contract a dangerous dose then, as well.

So we want to keep chicken pox away from vulnerable children. Now and then someone dodges through to adulthood without ever getting infected, though it is possible to get mild chicken pox without knowing it. If you`re not sure and you need to know -- as health workers do or a pregnant woman with an older child does -- you probably should have your blood tested for antibodies, which the body manufactures in self-defense once it has been exposed to the virus. No antibodies means no disease and that you are a perfect setup. Adults are more likely than children to have severe cases and to be more vulnerable to complications, from pneumonia to hepatitis.

Older pediatricians reminisce about chicken-pox parties. Once upon a time parents would gather their children together to expose them to the disease. It still makes perfect sense. No one can say for certain how soon a vaccine will be available.

Although it may still be sensible to expose children deliberately, few pediatricians suggest this. At my son`s day-care center, children are quarantined as soon as possible. Accordingly, the parents go on year after year waiting for each of their children to get it. And there is no prize for evading the disease as a child; you only become more vulnerable later.

Because of the disease`s low mortality rate in children, a vaccine was not originally a high priority. With varicella there was always the fear that if a vaccine gave only temporary immunity there would eventually be many adults who would get seriously ill as the vaccine wore off. It is hoped that the new vaccine will give long-term protection. If it does, it will be an obvious boon to children with AIDS and other immune deficiencies, as well as pregnant women and health-care workers, say, who have never had the disease.

The time between initial exposure to the varicella zoster virus that causes chicken pox and the appearance of the first skin spots is about two weeks, though it can be as long as three. And right before those spots appear, before anyone knows about them for sure, the chicken-pox victim is spreading disease left and right.

After the varicella virus has brought on the sickness, it infects certain target cells in which it settles down for a long latent period. (The virus is a member of the herpes group and in this regard it is similar to simplex 1 and 2 viruses, or the Epstein-Barr, which causes infectious mononucleosis.)